Adult ; Animals ; Endometrium ; parasitology ; physiopathology ; Enterobiasis ; complications ; drug therapy ; Enterobius ; drug effects ; pathogenicity ; Female ; Humans ; Menstruation Disturbances ; drug therapy ; parasitology ; Treatment Outcome

Defects involving specialised areas with characteristic anatomical features, such as the nipple, upper eyelid, and lip, benefit greatly from the use of sharing procedures. The vulva, a complex 3-dimensional structure, can also be reconstructed through a sharing procedure drawing upon the contralateral vulva. In this report, we present the interesting case of a patient with chronic, massive, localised lymphedema of her left labia majora that was resected in 2011. Five years later, she presented with squamous cell carcinoma over the left vulva region, which is rarely associated with chronic lymphedema. To the best of our knowledge, our management of the radical vulvectomy defect with a labia majora sharing procedure is novel and has not been previously described. The labia major flap presented in this report is a shared flap; that is, a transposition flap based on the dorsal clitoral artery, which has consistent vascular anatomy, making this flap durable and reliable. This procedure epitomises the principle of replacing like with like, does not interfere with leg movement or patient positioning, has minimal donor site morbidity, and preserves other locoregional flap options for future reconstruction. One limitation is the need for a lax contralateral vulva. This labia majora sharing procedure is a viable option in carefully selected patients.
Arteries ; Carcinoma, Squamous Cell ; Eyelids ; Humans ; Leg ; Lip ; Lymphedema ; Nipples ; Patient Positioning ; Perineum ; Tissue Donors ; Vulva

INTRODUCTIONThe clinical management of Smooth Muscle Tumours of Uncertain Malignant Potential (STUMPs) remains controversial because little is known about the natural history of these tumours and pathological classifications do not correlate well with clinical outcomes and therefore cannot direct management. The objective of this study was to review a single institution's experience with STUMP and recommend a rational clinical approach to the management of patients with this histological diagnosis.

MATERIALS AND METHODSA systematic review of all diagnoses of STUMP and leiomyosarcoma from the gynaecologic oncology and pathology databases between January 1970 and February 2006.

RESULTSA total of 18 diagnoses of STUMP and 72 diagnoses of Ieiomyosarcoma were made during the study period. None of these 72 cases of leiomyosarcoma had a prior diagnosis of STUMP. There were no recurrences in the 18 cases of STUMP with all 18 cases being registered as disease-free after 5 years.

CONCLUSIONSWe recommend that patients with a diagnosis of STUMP be expectantly managed given the low likelihood of leiomyosarcomatous transformation, the lack of any evidence that adjuvant treatments result in better long-term outcomes and that recurrences are amenable to surgical resection with good outcomes.

Adult ; Female ; Humans ; Leiomyoma ; diagnosis ; pathology ; surgery ; Retrospective Studies ; Smooth Muscle Tumor ; diagnosis ; pathology ; surgery ; Uterine Neoplasms ; diagnosis ; pathology ; surgery ; Uterus ; pathology ; surgery

INTRODUCTIONThe risk of malignancy index (RMI) is a scoring system used to triage benign from malignant ovarian masses. We compared the specificity and sensitivity of the four indices (RMI 1, RMI 2, RMI 3 and RMI 4) to discriminate a benign ovarian mass from a malignant one in a Southeast Asian population.

METHODSThis was a five-year retrospective study of women who were admitted for surgery due to ovarian masses. RMI scores were calculated based on standardised preoperative cancer antigen (CA)-125 levels, ultrasonography findings, menopausal status and tumour size based on ultrasonography. Postoperative histopathologic diagnosis was regarded as the definite outcome. Data were analysed using the Statistical Package for the Social Sciences, and Mann-Whitney U test was used to compare the individual RMI scores between the benign and malignant cases.

RESULTSOut of the 480 patients reviewed, 228 women aged 10-65 years were included in the study. Of these, 17 (7.5%) had malignant disease and 211 (92.5%) had benign pathology. There was no statistical difference in the RMI 1, 2, 3 and 4 scores between the benign and malignant cases. Individual variables that were analysed showed significant differences in median CA-125 level and tumour size (p = 0.044 and p < 0.0005, respectively) between the benign and malignant cases.

CONCLUSIONOur study shows that RMI is not a valuable triage tool for our Southeast Asian population. Further prospective validation, with regard to standardising results in different patient populations and centres, is required.

Adolescent ; Adult ; Aged ; Area Under Curve ; CA-125 Antigen ; metabolism ; Child ; Diagnosis, Differential ; Female ; Humans ; Middle Aged ; Models, Statistical ; Ovarian Cysts ; diagnosis ; pathology ; Ovarian Neoplasms ; diagnosis ; pathology ; ROC Curve ; Retrospective Studies ; Risk ; Sensitivity and Specificity ; Singapore ; Young Adult

INTRODUCTIONRobotic-assisted gynaecologic surgery is gaining popularity and it offers the advantages of laparoscopic surgery whilst overcoming the limitations of operative dexterity. We describe our experience with the fi rst 40 cases operated under the GRACES (Gynaecologic Robot- Assisted Cancer and Endoscopic Surgery) programme at the Department of Obstetrics & Gynecology, National University Hospital, Singapore.

MATERIALS AND METHODSA review was performed for the fi rst 40 women who had undergone robotic surgery, analysing patient characteristics, surgical timings and surgery-related complications. All cases were performed utilising the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) with 3 arms and 4 ports. Standardised instrumentation and similar cuff closure techniques were used.

RESULTSSeventeen (56%) were for endometrial cancer and the rest, for benign gynaecological disease. The mean age of the patients was 52.3 years. The average docking time was 11 minutes (SD 0.08). The docking and operative times were analysed in tertiles. Data for patients with endometrial cancer and benign cases were analysed separately. There were 3 cases of complications- cuff dehiscence, bleeding from vaginal cuff and tumour recurrence at vaginal vault.

CONCLUSIONOur caseload has enabled us to replicate the learning curve reported by other centres. We advocate the use of a standard instrument set for the fi rst 20 cases. We propose the following sequence for successful introduction of robot-assisted gynaecologic surgery - basic systems training, followed shortly with a clinical case, and progressive development of clinical competence through a proctoring programme.

Adult ; Aged ; Endometrial Neoplasms ; economics ; surgery ; Female ; Genital Diseases, Female ; economics ; surgery ; Gynecologic Surgical Procedures ; economics ; instrumentation ; methods ; Hospitals, Teaching ; Humans ; Learning ; Middle Aged ; Retrospective Studies ; Robotics ; economics ; instrumentation ; Singapore ; Surgery, Computer-Assisted ; economics ; instrumentation ; methods ; Time Factors ; Treatment Outcome

OBJECTIVE: To evaluate uterine and ovarian cancer mortality trends in East Asian countries. METHODS: For three Asian countries and one region (Japan, Korea, Singapore, and Hong Kong), we extracted number of deaths for each year from the World Health Organization (WHO) mortality database, focusing on women > or =20 years old. The WHO population data were used to estimate person-years at risk for women. The annual age-standardized, truncated rates were evaluated for four age groups. We also compared age-specific mortality rates during three calendar periods (1979 to 1988, 1989 to 1998, and 1999 to 2010). Joinpoint regression was used to determine secular trends in mortality. To obtain cervical and uterine corpus cancer mortality rates in Korea, we re-allocated the cases with uterine cancer of unspecified subsite according to the proportion in the National Cancer Incidence Databases. RESULTS: Overall, uterine cancer mortality has decreased in each of the Asian regions. In Korea, corrected cervical cancer mortality has declined since 1993, at an annual percentage change (APC) of -4.8% (95% confidence interval [CI], -5.3 to -4.4). On the other hand, corrected uterine corpus cancer mortality has abruptly increased since 1995 (APC, 6.7; 95% CI, 5.4 to 8.0). Ovarian cancer mortality was stable, except in Korea, where mortality rates steadily increased at an APC of 6.2% (95% CI, 3.4 to 9.0) during 1995 to 2000, and subsequently stabilized. CONCLUSION: Although uterine cancer mortality rates are declining in East Asia, additional effort is warranted to reduce the burden of gynecologic cancer in the future, through the implementation of early detection programs and the use of optimal therapeutic strategies.
Adult ; Age Distribution ; Aged ; Databases, Factual ; Far East/epidemiology ; Female ; Genital Neoplasms, Female/*mortality ; Humans ; Middle Aged ; Mortality/trends ; Ovarian Neoplasms/mortality ; Uterine Neoplasms/mortality ; Young Adult

Humans ; Female ; Human Papillomavirus DNA Tests ; Early Detection of Cancer ; Prospective Studies ; Uterine Cervical Neoplasms/diagnosis* ; Singapore

Introduction: Previous literature suggests that good nutrition knowledge does not necessarily translate into desired eating behaviours among adolescent athletes, which may affect their sports performance. The purposes of the study were twofold, which were to examine nutrition knowledge and practice between the sexes, and to evaluate the magnitude of relationship between nutrition knowledge and practice among adolescent handball athletes in Malaysia. Methods: Three hundred and twelve male and female adolescent handball players competing in a national level competition voluntarily participated in this study. The participants were asked to complete a questionnaire which consisted of items on their demographic information and about their nutrition knowledge and eating practices. Independent t-test and Pearson’s correlation were used to compare nutrition knowledge and practice between the sexes and to describe the relationship between variables, respectively. Results: The results showed that there were no significant differences (p>0.05) observed for nutrition knowledge and practice between the sexes. Besides, the results demonstrated that nutrition knowledge had a significant but weak positive correlation with eating habit (r=0.114, p=0.003) among the athletes. Conclusion: This study showed that nutrition knowledge and practice were moderately adequate, and that knowledge does not necessarily translate into good dietary practices. Therefore, the athletes would benefit from a comprehensive and innovative nutrition education, a strategy which warrants further investigation.